A variety of orthopedic devices, including bone fixation, reduction, and distraction devices, are known in the art. Fixation devices, or fixators, are used to stabilize bone segments and to facilitate the healing of bones at a bone repair site. As used herein “bone repair site” refers to any bone region which is bounded on opposing sides by relatively healthy bone regions to which orthopedic devices can be secured, such as an osteotomy or a fracture. Reduction and distraction devices (commonly referred to as reducers and distractors), are used to gradually adjust the relative orientation and spacing of the bone parts on opposing sides of a bone repair site.
Fixators generally consist of transcutaneous pins or screws secured in the bone on either side of the bone repair site. An adjustable external fixation mechanism is attached to the pins, allowing the relative positions of the pins to be adjusted, thus aligning the bone regions across the bone repair site. When the desired alignment is achieved, the fixation mechanism is locked in place to maintain the alignment. After the bone repair site has healed, the fixator is removed from the patient.
Reducers and distractors typically have structure similar to fixators, except that they additionally include a mechanism which allows controlled incremental adjustment of the distance between parts of the device on opposing sides of the bone repair site. Typically, distractors are used to perform distraction osteogenesis. This procedure was perfected by the Russian orthopedic doctor, Gavriel Ilizarov. A typical procedure of this type involves at most an osteotomy completely separating the bone into two segments, or at least an incision of the cortical portion of the bone. Then, the bone segments on either side of the osteotomy (or the medullary or cancellous portion of the bone on either side of the incision) maybe expanded. This gradual separation allows new bone to form in the osteotomy void. The distraction phase is followed by a consolidation phase, during which the distractor is held fixed, and the new bone growth gains strength. Following the consolidation phase, the distractor is removed from the patient.
The design of the early fixators and distractors, which used bone pins and screws to attach the device to the bone are known to have certain problems. For example, numerous pins are needed to attach a single device; at a minimum, two pins are required, but typically, many more are used. Each pin involves a transcutaneous incision, thus multiplying the risk of infection to the patient. Furthermore, a pin clamp or coupling is required to join the fixation/distraction mechanism to the pins, and the design and operation of these couplings are complicated by the difficulty in aligning the pins accurately when they are inserted into the bone. Finally, because the pins extend in a generally perpendicular direction from the insertion site, they cause the resultant overall device to stick out quite far from the patient's body (i.e., the device has a high profile), and the device is unsightly. A high-profile device is more subject to bumps and snags than one which is completely located close to the patient's body. Such seemingly aesthetic considerations are also important because a high-profile device may be rejected by prospective patients, especially children.
Accordingly, more recent devices have been designed not to use transcutaneous pins for attachment to the bone, but rather to use more low-profile bone anchors, such as plates with screw holes, as part of a low-profile overall device. This improved prior art is exemplified by U.S. Pat. No. 5,364,396 to Robinson et al. (“the Robinson patent”), which discloses an implantable bone distraction device which includes low profile blocks for attachment to osteotomically separated bone sections. The entire device can be implanted subcutaneously, except for a transcutaneous actuator assembly which is linked to the implanted distraction assembly, and allows adjustment of the distraction distance from outside the patient's body.
However, modem low-profile fixation/distraction systems such as that disclosed in the Robinson patent suffer from the drawback that their use necessitates two substantial, invasive, surgical procedures: one to implant the device, and another to remove it after the fixation/distraction procedure is complete. Unnecessary surgical procedures are of course undesirable, based on both considerations of health care costs and the medical risks associated with surgery.
Accordingly, there is a need in the art to provide a low-profile fixator/distractor that does not require a second surgical procedure to remove the device after the fixation/distraction procedure is complete. Indeed, there is a need in the orthopedic device art more generally, to provide a device that does not require a second surgical procedure to remove the device after the orthopedic procedure is complete.